What does a glioblastoma look like?

Guest post by James G. Smirniotopoulos, MD, chief editor for MedPix®.

Arizona Senator and former Vietnam POW John McCain was recently diagnosed with the most aggressive form of brain cancer: glioblastoma. This is the same type of tumor that killed Vice President Joe Biden’s son Beau and Senator Ted Kennedy.

Glioblastoma originates in the brain. It arises from astrocytes, one of the supporting cells of the brain, and grows by sending tendrils into the surrounding tissue.

Because of its diffuse nature, glioblastoma is not curable. However, surgery to remove as much of the tumor as possible, followed by both radiation and chemotherapy, has improved the prognosis. Median survival rates—which means half the patients live longer and half die sooner—now run 15-18 months, whereas 5-10% of patients live five years following diagnosis. Novel treatments, including immunotherapy, have been effective in some patients.

The symptoms of glioblastoma can vary, depending on the part of the brain in which it occurs. Different parts of the brain perform different functions, so some tumors cause seizures, while others may cause numbness or speech problems. Some of the most common symptoms are:

Headaches

Nausea and vomiting

Changes in your ability to talk, hear, or see

Problems with balance or walking

Problems with thinking or memory

Feeling weak or sleepy

Changes in your mood or behavior

Seizures

Doctors diagnose glioblastomas and other brain tumors by doing a neurologic exam and tests including an MRI, CT scan, and biopsy.

For example, the following images show two different glioblastomas. The image on the left is from an MRI (axial, T2-weighted) of Patient A and that on the right is an axial gross cut-section from Patient B. The tumors, outlined in red, show a general similarity in shape and size, and both tumors have distorted the brain and compressed normal structures, like the cerebral ventricles (blue outline) that contain cerebrospinal fluid.

MedPix images of similar glioblastomas from two different patients show the tumors (outlined in red) pushing on the surrounding tissue and compressing the cerebral ventricles (highlighted in blue).

Launched in 1999, MedPix now holds over 54,000 images from more than 12,000 patients, including unique whole brain sections from the era preceding non-invasive diagnosis using MRI and CT imaging. Designed as a teaching file, the database includes clinical information about each patient, along with their diseases and diagnoses. The medical cases in MedPix have been peer-reviewed and pathologically proven, making them an excellent resource for teaching and learning about disease.

Guest blogger James G. Smirniotopoulos, MD, serves as chief editor for MedPix. Now retired and a special volunteer at NLM, Smirniotopoulos formerly served as a professor and chair of radiology at the Uniformed Services University of the Health Sciences.